Summary
Definition
History and exam
Other diagnostic factors
- recent sore throat or scarlet fever
- chest pain
- shortness of breath
- palpitations
- heart murmur
- pericardial rub
- signs of cardiac failure
- swollen joints
- restlessness
- clumsiness
- emotional lability and personality changes
- jerky, uncoordinated choreiform movements
- inability to maintain protrusion of the tongue
- milkmaid's grip
- spooning sign
- pronator sign
- erythema marginatum
- subcutaneous nodules
- pregnancy or taking oral contraceptive pill
Risk factors
- poverty
- overcrowded living quarters
- family history of rheumatic fever
- D8/17 B cell antigen positivity
- HLA association
- genetic susceptibility
- indigenous populations; Aboriginal Australian, Asian, and Pacific Islanders
Diagnostic investigations
1st investigations to order
- erythrocyte sedimentation rate (ESR)
- CRP
- WBC count
- blood cultures
- electrocardiogram
- chest x-ray
- echocardiogram
- throat culture
- rapid antigen test for group A streptococci
- anti-streptococcal serology
Treatment algorithm
Contributors
Authors VIEW ALL
Senior Lecturer in Paediatrics
University of Auckland
Paediatric Infectious Diseases Specialist
Starship Children's Hospital and Middlemore Hospital
Auckland
New Zealand
Disclosures
RW declares that she has no competing interests; she is an active researcher and clinician in acute rheumatic fever/rheumatic heart disease and is a co-investigator on a (non-industry) grant funded by the Health Research Council of New Zealand and gives educational talks and has prepared manuscripts on rheumatic fever solely in capacity as a University of Auckland academic and Paediatric Infectious Diseases Specialist.
Dr Rachel Webb would like to gratefully acknowledge Dr Andrew C. Steer and Dr Jonathan Carapetis, previous contributors to this topic.
Peer reviewers VIEW ALL
Professor of Pediatrics
Division of Pediatric Cardiology
Faculty of Medicine
University of Alexandria
Cardiologist
El Shatby Children's Hospital
Alexandria
Egypt
Disclosures
SZ declares that she has no competing interests.
Paediatric Cardiologist/Interventional Cardiologist
Paediatric and Congenital Cardiac Services
Green Lane Clinical Services
Starship Children's Hospital
Auckland
New Zealand
Disclosures
NW declares that he has no competing interests.
Assistant Professor of Pediatrics
Medical University of South Carolina
Charleston
SC
Disclosures
AS declares that she has no competing interests.
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